先天性心脏病课件

先天性心脏病

CongenitalHeartDisease(CHD)先天性心脏病CongenitalHeartDiseasCHD：CongenitalHeartDiseaseVSD：VentricularseptaldefectASD：AtrialseptaldefectPDA：PatentductusarteriosusTOF：TetralogyofFallotPulmonaryhypertensionHemodynamicsShuntHeartmurmurTwo-dimensionalechocardiogramgramECG：electrocardiogramInterventionaltherapyCHD：CongenitalHeartDisease概述

Overview先天性心脏病是胎儿时期心脏血管发育异常而导致的先天性畸形CHDisdefinedasanabnormalityincirculatorystructureorfunctionthatispresentatbirth,evenifitisdiscoveredmuchlater出生缺陷监测先天性心血管发育畸形出现率25.1/10

000CHDispresentin25.1/10000inChina

概述Overview先天性心脏病是胎儿时期心脏血管发育异常概述

Overview由于各种心血管检查技术（特别是彩色多普勒超声心动图）的应用，深低温麻醉和体外循环下心内直视手术的发展，先心病介入性治疗进展，临床上对先心病的诊断和治疗发生了很大变化，预后大为改观。Bytheprogressionofallkindsofinspectiontechniquesandinterventionaltherapy,theprognosisischangedgreatly.概述Overview由于各种心血管检查技术（特别是彩色多普目的要求

Objective＆

Request了解胎儿血液循环及出生后血流动力学变化

Tounderstand

changesoffetuscirculation

andhemodynamics

beforeandafterbirth熟悉先天性心脏病的病因、分类、预防及治疗原则Tofamiliarwiththe

etiology

and

classificationofCHD掌握室间隔缺损、房间隔缺损、动脉导管未闭、法洛四联症的血流动力学、临床表现及常见并发症Tomasterthe

hemodynamicsand

clinicalsituationandthe

diagnosisofcommoncomplicationsinVSD,ASD,PDAandTOF

目的要求Objective＆Request了解胎儿血液循胎儿血液循环Fetuscirculation胎儿营养及代谢物质交换、氧气及二氧化碳交换均靠胎盘进行胎儿左右两侧心脏均向全身供血，肺循环血少，循环通过异常通道(卵圆孔、动脉导管)维持动静脉血并非绝对清楚，循环效率不如成人高，但胎儿循环途径既适合于胎内由胎盘吸氧，又适合于出生后转换为以肺取氧的循环通道，胎儿循环有效而灵活胎儿血液循环胎儿营养及代谢物质交换、氧气及二氧化碳交换均靠胎出生后血流动力学变化六条通道关闭，肺循环建立

脐血管阻断形成韧带(脐动脉2根，脐静脉1根)(6-8周)

呼吸建立，肺部血管扩张建立肺循环卵圆孔关闭(5-7月)

动脉导管闭合(3-4月)

静脉导管闭合(断脐后)出生后血流动力学变化六条通道关闭，肺循环建立脐血管阻断形成病因

Etiology

遗传因素(内在因素)

与基因突变、染色体畸变有关Geneticfactor(internalfactor)CHDresultfromgenemutationorchromosomeaberration环境因素(外界因素)

与宫内病毒感染有关Environmentalfactor(externalfactor)CHDismainlycorrelationtotheintrauterineinfection

病因Etiology遗传因素(内在因素)与基因突变、预防

Prevention一级预防：孕妇保健Primaryprevention：pregnantwomanhealth二级预防：提高产前诊断技术，选择性终止妊娠，减少先心病发生Secondaryprevention:improveprenataldiagnosistechnology,selectiveterminationofpregnancyandreducehappencongenitalheartdisease三级预防：治疗出生后畸形Tertiaryprevention:treatborndeformity预防一级预防：孕妇保健二级预防：提高产前诊断技术，选择性终分类Classification左向右分流型(潜在青紫型)

left-to-rightshunts(noncyanosis)右向左分流型(青紫型)

right-to-leftshunts(cyanosis)无分流型(无青紫型)

nonshunts(noncyanosis)分类Classification左向右分流型(潜在青紫型)临床常见的先心病CommonCHDinClinic●室间隔缺损

Ventricularseptaldefect(VSD)

●房间隔缺损

Atrialseptaldefect(ASD)●动脉导管未闭

Patentductusarteriosus(PDA)●法洛四联症

TetralogyofFallot(TOF)临床常见的先心病●室间隔缺损Ventriculars室间隔缺损

VentricularSeptalDefect（VSD）室间隔缺损室间隔缺损

血流动力学示意图

HemodynamicsFigureofVSD室间隔缺损血流动力学示意图HemodynamicsAnatomopathologicalDiagramofVSDAnatomopathologicalDiagramof室间隔缺损血流动力学变化HemodynamicsofVSD小室缺

可无血流动力学变化SmallVSD

nohemodynamicschanges

大室缺

大量左向右分流LargeVSD

Largeleft-to-rightshunts梗阻型肺动脉高压

ObstructedPH艾森门格综合征

EisenmengerSyndrome肺动脉高压PulmonaryHypertension(PH)动力型肺动脉高压

DynamicPH室间隔缺损血流动力学变化小室缺可VSD临床表现ClinicalfindingsofVSD●症状

Symptoms

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarsenessVSD临床表现ClinicalfindingsofVSVSD临床表现ClinicalfindingsofVSD●体征

Signs

LSB3-4可闻3-4/6级粗糙全收缩期吹风样杂音，向周围广泛传导，伴震颤Agrade3-4/6,medium-to-highpitched,harshpansystolicmurmurattheleftsternalborder(LSB)inthe3rdand4thintercostalspaces肺动脉瓣第二音亢进ThepulmonarycomponentofS2isaccentuationinintensity合并主动脉瓣关闭不全时可闻舒张期杂音

AdiastolicmurmurindicateVSDcombinewithaorticregurgitation

小中VSD临床表现ClinicalfindingsofVS室间隔缺损并发症ComplicationofVSD●支气管肺炎

Bronchopneumonia●充血性心力衰竭

Congestiveheartfailure●肺水肿

Pulmonaryedema●感染性心内膜炎

Infectiveendocarditis室间隔缺损并发症ComplicationofVSD●支气先天性心脏病课件房间隔缺损

Atrial

SeptalDefect（ASD）房间隔缺损房间隔缺损

血流动力学示意图

Hemodynamics

Figure

of

ASD房间隔缺损血流动力学示意图Hemodynamics上、下腔静脉血肺静脉

右心房（扩大）左心房

右心室（增大）左心室（血量减少）肺血流量明显增加（肺充血）肺小动脉痉挛、增厚体循环供血不足

右向左分流

（消瘦、乏力、心悸、气短等）艾森门格综合征(少数病人晚期）房间隔缺损血流动力学变化HemodynamicsofASDASD上、下腔静脉血ASD临床表现ClinicalfindingsofASD●症状

Symptoms

同室缺相似

SymptomsofASDaresimilarwiththatofVSD

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarsenessASD临床表现ClinicalfindingsofASASD临床表现ClinicalfindingsofASD●体征

Signs

LSB2-3可闻1-3/6级柔和收缩期喷射音，无震颤Agrade1-3/6ejectionSMisheardbestattheLSBinthe2ndintercostalspace，nothrillP2固定分裂S2atthepulmonaryareaiswidelysplitandoftenfixed肺动脉瓣第二音亢进ThepulmonarycomponentofS2isaccentuationinintensity三尖瓣区可闻舒张期杂音Amid-diastolicmurmurcanoftenbeheardintricuspidareaASD临床表现ClinicalfindingsofASXRayofsecundumASD肺野充血，肺动脉段突出，右房、右室增大。XRayofsecundumASD肺野充血，肺动脉先天性心脏病课件房间隔缺损并发症ComplicationofASD●支气管肺炎

Bronchopneumonia●充血性心力衰竭

Congestiveheartfailure●感染性心内膜炎

Infectiveendocarditis房间隔缺损并发症ComplicationofASD●支气动脉导管未闭

Patentductusarteriosus(PDA）动脉导管未闭动脉导管未闭

血流动力学示意图

HemodynamicsFigureofPDA动脉导管未闭血流动力学示意图HemodynamicsAnatomopathologicalDiagramofPDAAnatomopathologicalDiagramof右心室血流体循环舒张压肺动脉主动脉供血减少脉压增宽肺血流量肺动脉高压艾森门格综合征左房、左室扩大（差异性紫绀）（右心室肥大）动脉导管未闭血流动力学变化HemodynamicsofPDAPDA右心室血流动脉导管未闭血流动力学变化HemodynaPDA临床表现ClinicalfindingsofPDA●症状

Symptoms

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarseness与VSD及ASD相同

SymptomsofPDAaresimilarwiththatofVSDandASDPDA临床表现ClinicalfindingsofPDPDA临床表现ClinicalfindingsofPDA●体征

Signs

LSB2闻及粗糙、响亮的连续性机器样杂音，占据整个收缩期及舒张期Acharacteristicthrillandcontinuousandrough“machinery”murmurwithalatesystolicaccentuation

心尖区可闻及舒张中期隆隆样杂音Adiastolicflowmurmurisoftenheardattheapex周围血管征Peripheralvascularsigh

下半身青紫(差异性紫绀)和杵状趾Differentialcyanosisandclubbing

PDA临床表现ClinicalfindingsofPD先天性心脏病课件S1S2PDA堵闭前心音图S1S2PDA堵闭前心音图PDA堵闭后心音图S1S2PDA堵闭后心音图S1S2动脉导管未闭并发症ComplicationofPDA●支气管肺炎

Bronchopneumonia●感染性心内膜炎Infectiveendocarditis●感染性动脉炎Infectivearteritis●充血性心力衰竭

Congestiveheartfailure动脉导管未闭并发症ComplicationofPDA●支左向右分流先心病共同临床特点Commonfeaturesofleft-to-rightshuntingCHD●一般情况下无青紫Ingeneraltherearenoncyanosis●心前区有粗糙的杂音Aroughmurmurisheardinprecordium●肺循环血量多，易患肺炎Pulmonaryflowincreaseandeasytosufferfrombronchopneumonia●体循环血量少，影响生长发育Systemicflowdecreaseandthepatientgrowslowly左向右分流先心病共同临床特点Commonfeatures法洛四联症TetralogyofFallot（TOF）法洛四联症法洛四联症四种解剖畸形ThefourmalformationsofTOF●肺动脉狭窄Obstructiontorightventricularoutflow●室间隔缺损

Ventricularseptaldefect

●主动脉骑跨

Overridingoftheaorta●右心室肥厚Rightventricularhypertrophy

法洛四联症四种解剖畸形●肺动脉狭窄Obstructiont法洛四联症

血流动力学示意图

HemodynamicsFigureofTOF法洛四联症血流动力学示意图Hemodynamics法洛四联症血流动力学变化HemodynamicsofTOF右心室（肥厚）左心室

肺动脉狭窄主动脉

（血流量、扩张）肺血流量减少（肺野清晰）混合血进入循环

（青紫、发育落后、乏力血氧合不足

（杵状指趾等）

蹲踞、阵发性昏厥）分流法洛四联症血流动力学变化HemodynamicsoTOF临床表现ClinicalfindingsofTOF

●青紫本病最突出的症状Cyanosisisthemainsymptoms

●气促和缺氧发作Dyspneaandhypoxemicspells

●蹲踞症状Squattingposture

●杵状指趾

Clubbingoftheterminaldigits

●心脏体征LSB2-4闻及2-4/6级收缩期喷射性杂音,P2减弱Thereisagrade2-4/6,rough,ejection-typeSMthatismaximalattheLSBinthe2ndto3rdintercostalspaceandthatradiateswelltotheback.ThepulmonarycomponentofS2weaken

inintensityTOF临床表现ClinicalfindingsofTO杵状指Clubbingoffingers

杵状指Clubbingoffingers杵状指趾

Clubbingoffingersandtoes杵状指趾Clubbingoffingersand先天性心脏病课件X线检查

右室大、心尖上翘呈靴形，肺动脉段凹陷，肺野清晰XRayofTOFX线检查XRayofTOF先天性心脏病课件

右室造影AO和PA同时显影，大动脉关系正常，RVOT变窄，AO内径增宽并骑跨于室间隔上。右室造影AO和PA同时显影，大动脉关系正常，RVOT变窄，法洛四联症并发症ComplicationofTOF●脑血栓

Cerebralembolism●脑脓肿

Cerebralabscess●感染性心内膜炎

Infectiveendocarditis法洛四联症并发症ComplicationofTOF●脑血先天性心脏病的诊断DiagnosisofCHD●病史

History●体查

Physicalexamination●心电图

Electrocardiogram●心脏X线检查ChestX-ray●超声心动图Echocardiogram●心导管检查和心血管造影Cardiaccatheterizationandangiocardiography先天性心脏病的诊断DiagnosisofCHD●病史H临床上有诊断意义的心脏杂音Clinicalsignificanceheartmurmur●全收缩期杂音

Pansystolicmurmur●收缩晚期杂音Latesystolicmurmur●舒张期杂音Diastolicmurmur●连续性杂音

Continuousmurmur●强度≥3/6级的杂音

Grade≥3/6murmur临床上有诊断意义的心脏杂音Clinicalsignific先天性心脏病的治疗TreatmentofCHD

●内科治疗Medicalmanagement治疗心衰，良好护理Anticongestiveheartfailuremeasures,goodnursing

●外科治疗Operationtreatment开胸心脏修补手术Repairthedefectthroughtransthoraciccardiacsurgeryoperation●自然闭合

Spontaneousclosure

先天性心脏病的治疗TreatmentofCHD●内科治先天性心脏病的治疗TreatmentofCHD

●介入治疗

Interventionaltreatment

利用堵闭器材导管关闭PDA、继发孔ASD、VSDCatheterizationclosurewithaninterventionaldeviceisgenerallyrecommendedforostiumsecundumASDandPDA

andVSD

先天性心脏病的治疗TreatmentofCHD●介入治

心血管各种介入治疗技术Allkindsofinterventionaltherapyincardiovasculardisease心血管各种介入治疗技术PDA介入治疗InterventionaltreatmentofPDAPDA介入治疗InterventionaltreatmenPDA介入治疗InterventionaltreatmentofPDA适应证（Amplatzer法：①左向右分流不合并需外科手术的心脏畸形的动脉导管未闭，动脉导管最窄直径≥2.0mm，年龄≥6个月，体重≥4kg。②外科术后残余分流。PDA介入治疗InterventionaltreatmenASD介入治疗InterventionaltreatmentofASDASD介入治疗InterventionaltreatmenASD介入治疗InterventionaltreatmentofASDASD介入治疗InterventionaltreatmenVSD介入治疗InterventionaltreatmentofVSDVSD介入治疗InterventionaltreatmenVSD介入治疗InterventionaltreatmentofVSDVSD介入治疗Interventionaltreatmen谢谢谢谢先天性心脏病

CongenitalHeartDisease(CHD)先天性心脏病CongenitalHeartDiseasCHD：CongenitalHeartDiseaseVSD：VentricularseptaldefectASD：AtrialseptaldefectPDA：PatentductusarteriosusTOF：TetralogyofFallotPulmonaryhypertensionHemodynamicsShuntHeartmurmurTwo-dimensionalechocardiogramgramECG：electrocardiogramInterventionaltherapyCHD：CongenitalHeartDisease概述

Overview先天性心脏病是胎儿时期心脏血管发育异常而导致的先天性畸形CHDisdefinedasanabnormalityincirculatorystructureorfunctionthatispresentatbirth,evenifitisdiscoveredmuchlater出生缺陷监测先天性心血管发育畸形出现率25.1/10

000CHDispresentin25.1/10000inChina

概述Overview先天性心脏病是胎儿时期心脏血管发育异常概述

Overview由于各种心血管检查技术（特别是彩色多普勒超声心动图）的应用，深低温麻醉和体外循环下心内直视手术的发展，先心病介入性治疗进展，临床上对先心病的诊断和治疗发生了很大变化，预后大为改观。Bytheprogressionofallkindsofinspectiontechniquesandinterventionaltherapy,theprognosisischangedgreatly.概述Overview由于各种心血管检查技术（特别是彩色多普目的要求

Objective＆

Request了解胎儿血液循环及出生后血流动力学变化

Tounderstand

changesoffetuscirculation

andhemodynamics

beforeandafterbirth熟悉先天性心脏病的病因、分类、预防及治疗原则Tofamiliarwiththe

etiology

and

classificationofCHD掌握室间隔缺损、房间隔缺损、动脉导管未闭、法洛四联症的血流动力学、临床表现及常见并发症Tomasterthe

hemodynamicsand

clinicalsituationandthe

diagnosisofcommoncomplicationsinVSD,ASD,PDAandTOF

目的要求Objective＆Request了解胎儿血液循胎儿血液循环Fetuscirculation胎儿营养及代谢物质交换、氧气及二氧化碳交换均靠胎盘进行胎儿左右两侧心脏均向全身供血，肺循环血少，循环通过异常通道(卵圆孔、动脉导管)维持动静脉血并非绝对清楚，循环效率不如成人高，但胎儿循环途径既适合于胎内由胎盘吸氧，又适合于出生后转换为以肺取氧的循环通道，胎儿循环有效而灵活胎儿血液循环胎儿营养及代谢物质交换、氧气及二氧化碳交换均靠胎出生后血流动力学变化六条通道关闭，肺循环建立

脐血管阻断形成韧带(脐动脉2根，脐静脉1根)(6-8周)

呼吸建立，肺部血管扩张建立肺循环卵圆孔关闭(5-7月)

动脉导管闭合(3-4月)

静脉导管闭合(断脐后)出生后血流动力学变化六条通道关闭，肺循环建立脐血管阻断形成病因

Etiology

遗传因素(内在因素)

与基因突变、染色体畸变有关Geneticfactor(internalfactor)CHDresultfromgenemutationorchromosomeaberration环境因素(外界因素)

与宫内病毒感染有关Environmentalfactor(externalfactor)CHDismainlycorrelationtotheintrauterineinfection

病因Etiology遗传因素(内在因素)与基因突变、预防

Prevention一级预防：孕妇保健Primaryprevention：pregnantwomanhealth二级预防：提高产前诊断技术，选择性终止妊娠，减少先心病发生Secondaryprevention:improveprenataldiagnosistechnology,selectiveterminationofpregnancyandreducehappencongenitalheartdisease三级预防：治疗出生后畸形Tertiaryprevention:treatborndeformity预防一级预防：孕妇保健二级预防：提高产前诊断技术，选择性终分类Classification左向右分流型(潜在青紫型)

left-to-rightshunts(noncyanosis)右向左分流型(青紫型)

right-to-leftshunts(cyanosis)无分流型(无青紫型)

nonshunts(noncyanosis)分类Classification左向右分流型(潜在青紫型)临床常见的先心病CommonCHDinClinic●室间隔缺损

Ventricularseptaldefect(VSD)

●房间隔缺损

Atrialseptaldefect(ASD)●动脉导管未闭

Patentductusarteriosus(PDA)●法洛四联症

TetralogyofFallot(TOF)临床常见的先心病●室间隔缺损Ventriculars室间隔缺损

VentricularSeptalDefect（VSD）室间隔缺损室间隔缺损

血流动力学示意图

HemodynamicsFigureofVSD室间隔缺损血流动力学示意图HemodynamicsAnatomopathologicalDiagramofVSDAnatomopathologicalDiagramof室间隔缺损血流动力学变化HemodynamicsofVSD小室缺

可无血流动力学变化SmallVSD

nohemodynamicschanges

大室缺

大量左向右分流LargeVSD

Largeleft-to-rightshunts梗阻型肺动脉高压

ObstructedPH艾森门格综合征

EisenmengerSyndrome肺动脉高压PulmonaryHypertension(PH)动力型肺动脉高压

DynamicPH室间隔缺损血流动力学变化小室缺可VSD临床表现ClinicalfindingsofVSD●症状

Symptoms

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarsenessVSD临床表现ClinicalfindingsofVSVSD临床表现ClinicalfindingsofVSD●体征

Signs

LSB3-4可闻3-4/6级粗糙全收缩期吹风样杂音，向周围广泛传导，伴震颤Agrade3-4/6,medium-to-highpitched,harshpansystolicmurmurattheleftsternalborder(LSB)inthe3rdand4thintercostalspaces肺动脉瓣第二音亢进ThepulmonarycomponentofS2isaccentuationinintensity合并主动脉瓣关闭不全时可闻舒张期杂音

AdiastolicmurmurindicateVSDcombinewithaorticregurgitation

小中VSD临床表现ClinicalfindingsofVS室间隔缺损并发症ComplicationofVSD●支气管肺炎

Bronchopneumonia●充血性心力衰竭

Congestiveheartfailure●肺水肿

Pulmonaryedema●感染性心内膜炎

Infectiveendocarditis室间隔缺损并发症ComplicationofVSD●支气先天性心脏病课件房间隔缺损

Atrial

SeptalDefect（ASD）房间隔缺损房间隔缺损

血流动力学示意图

Hemodynamics

Figure

of

ASD房间隔缺损血流动力学示意图Hemodynamics上、下腔静脉血肺静脉

右心房（扩大）左心房

右心室（增大）左心室（血量减少）肺血流量明显增加（肺充血）肺小动脉痉挛、增厚体循环供血不足

右向左分流

（消瘦、乏力、心悸、气短等）艾森门格综合征(少数病人晚期）房间隔缺损血流动力学变化HemodynamicsofASDASD上、下腔静脉血ASD临床表现ClinicalfindingsofASD●症状

Symptoms

同室缺相似

SymptomsofASDaresimilarwiththatofVSD

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarsenessASD临床表现ClinicalfindingsofASASD临床表现ClinicalfindingsofASD●体征

Signs

LSB2-3可闻1-3/6级柔和收缩期喷射音，无震颤Agrade1-3/6ejectionSMisheardbestattheLSBinthe2ndintercostalspace，nothrillP2固定分裂S2atthepulmonaryareaiswidelysplitandoftenfixed肺动脉瓣第二音亢进ThepulmonarycomponentofS2isaccentuationinintensity三尖瓣区可闻舒张期杂音Amid-diastolicmurmurcanoftenbeheardintricuspidareaASD临床表现ClinicalfindingsofASXRayofsecundumASD肺野充血，肺动脉段突出，右房、右室增大。XRayofsecundumASD肺野充血，肺动脉先天性心脏病课件房间隔缺损并发症ComplicationofASD●支气管肺炎

Bronchopneumonia●充血性心力衰竭

Congestiveheartfailure●感染性心内膜炎

Infectiveendocarditis房间隔缺损并发症ComplicationofASD●支气动脉导管未闭

Patentductusarteriosus(PDA）动脉导管未闭动脉导管未闭

血流动力学示意图

HemodynamicsFigureofPDA动脉导管未闭血流动力学示意图HemodynamicsAnatomopathologicalDiagramofPDAAnatomopathologicalDiagramof右心室血流体循环舒张压肺动脉主动脉供血减少脉压增宽肺血流量肺动脉高压艾森门格综合征左房、左室扩大（差异性紫绀）（右心室肥大）动脉导管未闭血流动力学变化HemodynamicsofPDAPDA右心室血流动脉导管未闭血流动力学变化HemodynaPDA临床表现ClinicalfindingsofPDA●症状

Symptoms

反复呼吸道感染，生长发育落后、乏力、气短、声嘶Repeatedrespiratoryinfection,growthanddevelopmentlagbehind,fatigue,shortnessofbreath,hoarseness与VSD及ASD相同

SymptomsofPDAaresimilarwiththatofVSDandASDPDA临床表现ClinicalfindingsofPDPDA临床表现ClinicalfindingsofPDA●体征

Signs

LSB2闻及粗糙、响亮的连续性机器样杂音，占据整个收缩期及舒张期Acharacteristicthrillandcontinuousandrough“machinery”murmurwithalatesystolicaccentuation

心尖区可闻及舒张中期隆隆样杂音Adiastolicflowmurmurisoftenheardattheapex周围血管征Peripheralvascularsigh

下半身青紫(差异性紫绀)和杵状趾Differentialcyanosisandclubbing

PDA临床表现ClinicalfindingsofPD先天性心脏病课件S1S2PDA堵闭前心音图S1S2PDA堵闭前心音图PDA堵闭后心音图S1S2PDA堵闭后心音图S1S2动脉导管未闭并发症ComplicationofPDA●支气管肺炎

Bronchopneumonia●感染性心内膜炎Infectiveendocarditis●感染性动脉炎Infectivearteritis●充血性心力衰竭

Congestiveheartfailure动脉导管未闭并发症ComplicationofPDA●支左向右分流先心病共同临床特点Commonfeaturesofleft-to-rightshuntingCHD●一般情况下无青紫Ingeneraltherearenoncyanosis●心前区有粗糙的杂音Aroughmurmurisheardinprecordium●肺循环血量多，易患肺炎Pulmonaryflowincreaseandeasytosufferfrombronchopneumonia●体循环血量少，影响生长发育Systemicflowdecreaseandthepatientgrowslowly左向右分流先心病共同临床特点Commonfeatures法洛四联症TetralogyofFallot（TOF）法洛四联症法洛四联症四种解剖畸形ThefourmalformationsofTOF●肺动脉狭窄Obstructiontorightventricularoutflow●室间隔缺损

Ventricularseptaldefect

●主动脉骑跨

Overridingoftheaorta●右心室肥厚Rightventricularhypertrophy

法洛四联症四种解剖畸形●肺动脉狭窄Obstructiont法洛四联症

血流动力学示意图

HemodynamicsFigureofTOF法洛四联症血流动力学示意图Hemodynamics法洛四联症血流动力学变化HemodynamicsofTOF右心室（肥厚）左心室

肺动脉狭窄主动脉

（血流量、扩张）肺血流量减少（肺野清晰）混合血进入循环

（青紫、发育落后、乏力血氧合不足

（杵状指趾等）

蹲踞、阵发性昏厥）分流法洛四联症血流动力学变化HemodynamicsoTOF临床表现ClinicalfindingsofTOF

●青紫本病最突出的症状Cyanosisisthemainsymptoms

●气促和缺氧发作Dyspneaandhypoxemicspells

●蹲踞症状Squattingposture

●杵状指趾

Clubbingoftheterminaldigits

●心脏体征LSB2-4闻及2-4/6级收缩期喷射性杂音,P2减弱Thereisagrade2-4/6,rough,ejection-typeSMthatismaximalattheLSBinthe2ndto3rdintercostalspaceandthatradiateswelltotheback.ThepulmonarycomponentofS2